Form N-15 - Individual Income Tax Return Nonresident And Part-Year Resident - 2000
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1
2STATE OF HAWAII — DEPARTMENT OF TAXATION
DO NOT WRITE OR STAPLE IN THIS SPACE
Form
Individual Income Tax Return
N-15
2000
NONRESIDENT and PART-YEAR RESIDENT
(Rev. 2000)
Calendar Year 2000
or other tax year beginning
, 2000 and ending
,
•
Check the applicable box:
Part-Year Resident
Nonresident
AMD UNP
008
PNT
INT
Check box if address is new or changed
Your first name and initial
Last name
Your social security number
If a joint return, spouse’s first name and initial
Last name
Spouse’s social security number
Present mailing or home address (Number and street, including apartment number or rural route)
Your occupation
City, town or post office, State and ZIP code
Spouse’s occupation
Note: Checking “Yes”
Do you want $2 to go to the Hawaii Election Campaign Fund? .................
Yes
No
HAWAII ELECTION
will not increase your tax
CAMPAIGN FUND
If joint return, does your spouse want $2 to go to the fund? ......................
Yes
No
or reduce your refund.
If you are a nonresident, in what state or foreign country are you a resident? __________________________________
RESIDENCY STATUS
1
Single
(Check only ONE box)
2
Married filing joint return (even if only one had income).
•
3
Married filing separate return. Enter spouse’s social security no. above and full name here.
4
Head of household (with qualifying person). If the qualifying person is your child but not your
dependent, enter this child’s name here.
•
5
Qualifying widow(er) with dependent child (Year spouse died
_________).
Caution: If you can be claimed as a dependent on another person’s tax return (such as your parents’), do not check box 6a, but be sure to check the box below line 35.
}
Enter number of boxes
6a
Yourself ...............................
Age 65 or over ..................................................................................
checked on 6a and 6b
6b
Spouse ................................
Age 65 or over ..................................................................................
Enter number of
6c
your children listed
Dependents:
If more than 2 dependents
2. Dependent’s social
6c
1. First and last name
use attachment
security number
3. Relationship
Enter number of
6d
other dependents
and
6d
Add numbers
6e
entered in
6e Total number of exemptions claimed
.........................................................................................................
boxes above
ATTACH A COPY OF YOUR FEDERAL INCOME TAX RETURN FOR 2000
Col. A - Total Income
Col. B - Hawaii Income
ROUND TO THE NEAREST DOLLAR
•
7 Wages, salaries, tips, etc. (attach Form(s) W-2)........................................................
00
7
00
•
8 Interest income from the worksheet on page 35 of the Instructions............................
8
00
00
•
9 Ordinary dividends ..................................................................................................
00
9
00
10 State income tax refund from the worksheet on page 35 of the Instructions...............
10
00
00
11 Alimony received.....................................................................................................
00
11
00
•
12 Business or farm income or (loss) G.E. I.D. No.
.................
12
00
00
•
13 Capital gain or (loss) from the worksheet on page 35 of the Instructions....................
00
13
00
14 Supplemental gains or (losses) (attach Schedule D-1)..............................................
14
00
00
15 IRA distributions ......................................................................................................
00
15
00
•
16 Pensions and annuities
..............
16
00
(see Instructions and attach Schedule J, Form N-11/N-12/N-15/N-40)
00
•
17 Rents, royalties, partnerships, estates, trusts, etc. G.E. I.D. No.
........
00
17
00
•
18 Unemployment compensation (insurance). ..............................................................
18
00
00
•
19 Other income (state nature and source) ..................................................................
00
19
00
20 Add lines 7 through 19............................................................... Total Income
20
00
00
21 IRA deduction .........................................................................................................
00
21
00
22 Student loan interest deduction from the worksheet on page 39 of the Instructions ....
22
00
00
23 Medical savings account deduction..........................................................................
00
23
00
24 Moving expenses (attach Form N-139) ....................................................................
24
00
00
25 One-half of self-employment tax ..............................................................................
00
25
00
26 Self-employed health insurance deduction ..............................................................
26
00
00
27 Self-employed SEP, SIMPLE, and qualified plans ....................................................
00
27
00
28 Interest penalty on early withdrawal of savings .........................................................
28
00
00
29 Alimony paid
..................................................................
00
29
(Enter name and SS No. of recipient)
00
•
30 Payments to an individual housing account ..............................................................
30
00
00
•
31 First $1,750 of military reserve or Hawaii national guard duty pay..............................
00
31
00
•
32 Add lines 21 through 31.................................................... Total Adjustments
32
00
00
•
•
33 Line 20 minus line 32.............................................. Adjusted Gross Income
00
33
AGI
00
FORM N-15
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